Sleep and Its Disorders in Children

Timothy F. Hoban, MD


Semin Neurol. 2004;24(3) 

In This Article

Other Parasomnias in Children

Nocturnal Enuresis

Nocturnal enuresis most commonly presents as a primary sleep disorder in otherwise healthy children who are unable to establish consistent nighttime continence by ~5 years of age. Enuresis is extremely common, affecting 15.7% of children between 3 and 13 years of age in one large study.[52] Enuresis persisted at the age of 13 in only 2.0% of patients, suggesting that the condition remits spontaneously for most affected children with advancing age. The cause of primary enuresis is unknown, although is has been postulated that it may result from deficient arousal from sleep, maturational lags, reduced functional bladder capacity, or genetic influences.[58] Serious underlying neurological and urologic causes are uncommon. Behavioral interventions are often effective, including scheduled voidings, wetness alarms, and bladder training exercises. Successful use of desmopressin and imipramine have also been reported, but these agents are ideally used within the context of a comprehensive and closely supervised treatment program.[59]


Nightmares in children are thought to result from awakening during REM sleep, usually with vivid recall of distressing dream imagery resulting in agitation. Although nightmares may superficially resemble night terrors, the fact that affected children are awake, consolable, and can describe dream content usually helps distinguish nightmares from NREM partial arousals. Nightmares most often occur during the second half of the night, when REM periods are longest and most prevalent. Occasional nightmares in children are thought to be common, with a prevalence of 57.6% in one large survey studying the sleep of 5- to 7-year old Swedish children.[60] Although "bad dreams" seldom require medical evaluation for the great majority of affected children, the presence of excessively frequent nightmares or dreams with particularly violent content may signal a need for further psychological investigation.


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